A kidney stones Q & A

UnityPoint Health Center for Urology provides comprehensive treatment for disorders affecting the male and female urinary tract. Our team treats conditions such as prostate cancer, bladder cancer, kidney cancer, testicular cancer, benign prostatic hypertrophy, erectile dysfunction, urinary incontinence, recurrent urinary tract infections, fertility and kidney stones. Typically, the organs considered part of the urology discipline are the kidneys, ureters, bladder, prostate, urethra, adrenal glands and male reproductive organs. For more information about our clinic, please visit unitypoint.org/FortDodgeUrology.

Dr. Eric Askeland is a member of the Urology team and a Fort Dodge native. Below he answers several commonly asked questions regarding kidney stones.

How do kidney stones form? They begin when urine becomes supersaturated, resulting in the formation of salts, which develop into crystals. Once a crystal is formed, it spurs more crystal formation, resulting in growth and eventually formation of a kidney stone.

What are kidney stones made of? There are many different types of kidney stones. In general, about 75 percent of kidney stones are calcium-based. Regardless of the type, most stones are treated the same. However, the type does help us tailor dietary alterations or medications to help prevent recurrence of stones.

What causes kidney stones? Diet and genetics are the two biggest risk factors, but there are several others:

• Gender: Historically, men are two to three times more likely to get stones than women.

• Race: Caucasians are more likely to develop kidney stones.

• Age: Stone occurrence peaks in people aged 35-45 years.

• Geography and climate: Areas with hot and dry climates tend to have a higher incidence of stone disease.

• Chronic dehydration: Chronic lack of appropriate fluid intake can increase risk.

• Presence of metabolic syndrome: A condition characterized by a cluster of disease processes including high blood pressure, high blood sugar, excess body fat and abnormal cholesterol levels, also has been found to increase a patient’s risk of stone disease.

Can you prevent kidney stones? We recommend dietary modifications in all patients with a history of kidney stones to prevent recurrence. In certain instances, patients can undergo metabolic testing to aid in identifying a cause for recurrent kidney stone formation. This testing involves blood tests and a urine collection test to identify abnormalities that we can target with dietary modifications or medications to prevent or delay the formation of new kidney stones.

What are kidney stone symptoms? Kidney stones do not cause pain until they block the flow of urine. Typically, patients come to the ER complaining of pain radiating from their flank region around the abdomen and toward the groin, depending on the location of the stone. Patients also frequently have nausea and vomiting associated with the pain. We become more worried when patients come to the ER with a fever or concern for infection. This occurs when patients develop a urinary tract infection on the obstructed side of the stone. In these cases, treatment is a relative emergency because antibiotics alone will not adequately treat the infection if the infected urine cannot drain.

Why do kidney stones hurt? It’s actually not the stone itself causing the pain, but the obstruction in the urinary tract that blocks the flow of urine. The pain from a kidney stone can vary, because pain itself is very subjective.

What are kidney stone treatments? Kidney stones can be treated with medication or surgery. If a patient has a relatively small stone, no evidence of infection, adequate pain control and sufficient kidney function, providers can attempt a trial of stone passage. In these scenarios, we usually give patients a medication, called an alpha-blocker, which increases the stone passage rate, decreases the time to stone passage and provides kidney stone pain relief.

Certain types of kidney stones can be dissolved with medications. However, if it is the patient’s first episode of kidney stones we do not know the type of kidney stone the patient has until after we treat and analyze the stone. This is more relevant in recurrent kidney stone formers, which is why it is important for us to analyze kidney stones at the time of treatment.

When patients have an obstructing kidney stone and an infection, it is imperative to treat the stone surgically. In these instances, a ureteral stent is placed to bypass the kidney stone and allow the infected urine to drain. Once the patient is free of infection, a provider will perform a second surgery for kidney stone removal. Surgery is also performed if a stone is too big to pass, if the patient has intractable pain/nausea/vomiting that cannot be managed as an outpatient or if the patient has a significant decline in kidney function because of the obstructing stone. There are a few different approaches to surgical stone treatment and the decision is based primarily on the stone size and location.

On rare occasions, patients may have a large or chronically obstructing stone, which causes a complete loss of kidney function. In these cases, there is no point in treating the stone because doing so would leave a non-functioning kidney. In this instance, the patient is often better served by complete removal of the kidney.

Eric J. Askeland, M.D., is affiliated with UnityPoint Health — Center for Urology.